The Timed Up and Go Test Is an Early Predictor of Functional Outcome After Hemiarthroplasty for Femoral Neck Fracture
Centre de recherche, Département de chirurgie, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, local K-3035, 5400 boulevard Gouin ouest, Montréal, Québec H4J 2C5, Canada. The Journal of Bone and Joint Surgery
(Impact Factor: 5.28).
07/2012; 94(13):1175-9. DOI: 10.2106/JBJS.J.01952
The ability to predict the long-term physical function and prognosis of hip fracture patients during the early postoperative period is essential for surgeons and physical therapists as well as for patients and their families. The purpose of this study was to determine whether early functional assessment correlated with and/or predicted long-term function after surgery to treat a displaced femoral neck fracture.
Sixty-two patients undergoing hemiarthroplasty for a displaced femoral neck fracture were evaluated prospectively; a minimum follow-up of two years was required. Validated functional assessments, including the Lower Extremity Measure and the Timed Up and Go test, were utilized, and scores were analyzed with respect to patient baseline data.
The functional level of patients decreased significantly after the injury, with the mean Lower Extremity Measure score decreasing from 87.7 to 62.4 and the need for a walking aid increasing from 36% to 54% at two years postoperatively (p < 0.05 for both). The Timed Up and Go test scores at four days and three weeks postoperatively were significantly higher in patients who needed a walking aid at two years compared with independently walking patients (p < 0.05). Receiver operating characteristic curve analysis of the Timed Up and Go test scores revealed that the optimal threshold for predicting the need for a walking aid at two years was fifty-eight seconds at four days postoperatively and twenty-six seconds at three weeks. Also, the need for a walking aid at two years was ninetyfold higher when the Timed Up and Go test score at three weeks postoperatively exceeded the twenty-six seconds threshold.
The Timed Up and Go test was an early clinical indicator of future physical function in patients with a hip fracture treated with hemiarthroplasty. Innovative clinical approaches to anticipate future function will contribute to increasing the efficiency of overall management of this growing set of patients.
Available from: Christopher Bliemel
- "Third, we assessed pre-fracture walking ability and BI retrospectively. In our opinion, this method was acceptable for assessing patients' pre-fracture function because it was used in some previous studies (Laflamme et al., 2012; Bellelli et al., 2012). Fourth, our different multivariate models could explain only part of the variance; for example, our model related to walking on stairs obtained an acceptable value of R 2 = 0.517, while our model for staying ability was nearly valueless (R 2 = 0.024), although many variables were integrated into our regression analysis. "
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The aim of the present study was to determine the independent factors influencing mobilization progress after geriatric hip fractures.
Patients and methods:
392 Hip fracture patients older than 60 years were included in this prospective, observational, cohort study. The progress of mobilization was measured with walking ability 4 days post-surgery, ability to climb stairs until discharge and the Tinetti test at discharge. Factors correlated with the progress of mobilization were determined using multivariate analyses.
The independent factors influencing walking ability 4 days post-surgery were the pre-fracture Charlson Comorbidity Index (OR=0.834, p=0.005), the American Society of Anesthesiologists Score (OR=0.550, p=0.013), pre-fracture Barthel Index ([BI], OR=1.019, p=0.012) and risk for depression, as measured by the Geriatric Depression Scale, (OR=0.896, p=0.013). The probability of climbing stairs until discharge was influenced by the patient's age (OR=0.840, p<0.001), pre-fracture BI (OR=1.047, p=0.042), cognitive impairment, as measured by the mini mental state examination (OR=1.182 p=0.008), pre surgical hemoglobin (OR=1.026, p=0.044), time until surgery (OR=0.961, p=0.023), duration of surgery (OR=0.982, p=0.014), and surgery type (prosthesis, OR=4.545, p=0.001). Similar variables influenced the Tinetti test ad discharge.
While pre-fracture co-morbidities and function cannot be changed, the treatment of patients with cognitive impairment and depressive symptoms should be optimized. Efforts should be undertaken to ensure early surgery for all hip fractures.
Available from: Andreas Unger
- "The TUG was performed one minute faster on average. Laflamme et al. showed in their study that TUG is an early clinical indicator of future physical function in geriatric patients with femoral neck fracture treated with hemiarthroplasty . At three weeks after the operation, patients who needed longer than 26 seconds to perform the test had a significantly higher probability of using a walker for 2 years after the operation. "
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ABSTRACT: Purpose :
The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH.
Materials and Methods :
The data of 180 geriatric patients with medial femoral neck fractures were evaluated retrospectively. The general and surgical complications, mobilisation using the Timed Up and Go test (TUG), the social environment pre- and postoperative and the radiological results have been compared with established approaches for geriatric hip surgery.
After joint replacement, 18 (10%) patients were developed pneumonia, of which 3 (1.7%) died during hospitalisation. In 7 cases (4%), surgical revision had to be carried out: three times (1.7%) because of a seroma, three times (1.7%) because of subcutaneous infection, and one time (0.6%) because the BHH was removed, owing to deep wound infection. One dislocation (0.6%) occurred, as well as one femoral nerve lesion (0.6%) occured. 88.3% of patients were mobilised on walkers or crutches; the Timed Up and Go Test showed a significant improvement during inpatient rehabilitation. 83% were discharged to their usual social environment, 10% were transferred to a short-term care facility and 7% were relocated permanently to a nursing home. 3/4 of patients had a cemented stem alignment in the range between -5° and 5°, while 2/3 of patients had a maximum difference of 1 cm in leg length.
Using the modified DAA, a high patient satisfaction is achieved after implantation of a BHH. The rate of major complications is just as low as in conventional approaches, and rapid mobilisation is possible.
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